Chase was named one of the most influential people in Digital Health due to his entrepreneurial success & writing along with luminaries such as Eric Topol, Patrick Soon-Shiong, Vinod Khosla & Elizabeth Holmes. He speaks to & consults with new ventures inside of established companies & high growth startups. Chase is widely published. The book Chase co-authored won the healthcare Book of the Year in in 2014.
Chase has a penchant for making connections between previously disconnected trends and making them understandable and actionable. Chase is in the development stage of a documentary that seeks to make the indecipherable understandable and demonstrate that there is reason for great optimism that a partnership between doc-entrepreneurs and forward-looking clinicians with individuals (fka “patients”) can dramatically out-perform against Quadruple Aim* objectives compared to traditional healthcare orgs.
*The Quadruple Aim is the Triple Aim (improved outcomes & patient experience with lower costs) plus the overlooked 4th Aim — clinician satisfaction critical to improving the current condition where an alarming number of clinicians are overburdened & burnt-out which negatively impacts their lives as well as the individuals they care for.
Chase was the CEO & Co-founder of Avado, which was acquired by and integrated into WebMD and the most widely used healthcare professional site - Medscape.
Before Avado, Chase spent several years outside of healthcare in startups as founder or consulting roles with LiveRez.com, MarketLeader, & WhatCounts. He also played founding & leadership roles in launching two new $1B+ businesses within Microsoft.
Chase is a father, husband & oxygen-fueled mt sport athlete. His 2014 team placed 3rd in their division & 24th overall (out of 500 teams) in America's oldest adventure race (7 legs -- XC ski, downhill ski, run, road bike, canoe, mt. bike & sea kayak) where Dave took on the Nordic ski leg. Dave was a former PAC-10 800 Meter competitor.

Fortunately, there is a solution that has bipartisan support and has shown to reduce utilization by 40-80% (e.g., Seattle-based Qliance) and overall costs 20-30%. It can be described as two parts Marcus Welby and one part Steve Jobs. The federal health reform bill included a little-noticed clause allowing for Direct Primary Care (DPC) models to be a part of the state health insurance exchanges. That little-noticed clause (Section 1301 (a)(3) of the Affordable Care Act and proposed HR3315 to expand DPC to Medicare recipients) should have the effect of massively spreading the DPC model throughout the country.

[Update: Washington state has started doing what is outlined in this article -- i.e., Medicaid recipients able to utilize DPC. Qliance is one of the DPC practices now caring for Medicaid recipients. When the ACA public exchanges launched, DPC became available to the general public resulting in explosive growth for Qliance.]

The future is already here — it’s just not very evenly distributed. – William Gibson

A common myth is DPC is the same or similar to their more expensive cousin — concierge medicine. Not so. Typically one-third of DPC practices are uninsured people. AtlasMD in Wichita, KS is run by Dr. Josh Umbehr who recently mentioned to me one of his patients. Due to tough economic times, she’s living in a storage unit. Her monthly fee ($50/mth which is inclusive of all fees) is less than she was paying in co-pays at the local public health facility. Another is MedLion. One of their recent clinics is in Salinas, CA (a farming community) and caters to farm workers . The waiting rooms are nicer than a public health facility because can put their resources towards a more pleasant experience than billing systems and personnel. AtlasMD has 2 MDs and one NP. No admin staff. Zero. Everything is low cost software, etc. Iora Health is now offering their DPC service to immigrants ineligible for Medicaid at a price point of $10/week (for full primary care).

[Contact me via LinkedIn -- www.linkedin.com/in/chasedave if you'd like a copy of the seminal study on the Direct Primary Care model that is part of Obamacare.]

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Let’s break down how it’s possible to provide such a high level of service at such an affordable price (i.e., less than a typical cable bill). It’s simple: low overhead. It’s not unusual for a primary care practice to have 3-5 administrative staff for every doctor. This is necessary to deal with the myriad insurance billing schemes that can best be described as a Gordian Knot designed by Rube Goldberg. Smart utilization of affordable technology (often in the low hundreds of dollars per month vs. many thousands and ongoing headaches) is at the heart of it. This allows the doctor to practice medicine the way they were trained, rather than pulling their hair out dealing with insurance for the medical equivalent of a trip to Jiffy Lube. In other words, the practices run similar to the fabled Marcus Welby, MD days. Yet, they are improved upon with a dose of Steve Jobs enabling enhancements that weren’t possible in the past such as virtual house calls. In anticipation of the rapid expansion of these models, entrepreneurs such as BJ Lawson, MD of Physician Care Direct have developed software to run the business side of these practices. [See more on how practices are overcoming obstacles to switching to Direct Primary Care.]

Thus far, DPC has had success in the private market. I put the question of why not use DPC for the Medicaid population to DPC practitioners. The response below is a summary of their perspective. It is estimated that if DPC was scaled nationally it could save 20-30% off of overall healthcare costs. That would be the difference between states defaulting and sustained balanced budgets.

The issue of using DPC for the poor is from my point of view a no brainer. Why use the most expensive inflationary system available (by which I mean the insurance system, whether public or private) to take care of those with the least money and most in need of basic services? The structure that makes sense to me is to create a thriving marketplace in direct primary care, competing on price, access and quality – and working exclusively for our patients. Then add a fixed monthly stipend for primary care for every Medicaid patient in the United States – a stipend that covers the lowest priced/highest functioning primary care available. This could be a voucher or credit card account for each Medicaid patient. The allowance could only be spent on primary care and the patients could buy up to higher priced practices if they saw value worth purchasing. That would convert the Medicaid patient from being a low paying, high utilizing patient to a valued customer who can pay cash for care at a reasonable price. This makes all kinds of sense economically:

No government management system to control or manage care – it manages itself with the patient at the helm.

Financially stabilizing the primary care world with consistent monthly fee payments to cover our fixed costs while allowing those docs with better ideas or higher prices to go for the upscale patients or those wanting better art work and longer visits.

Free up primary care docs to further improve their quality, access and patient centered services – not their billing savvy

If the government wanted to regulate, they could demand an annual report on each patient they support, giving the actual utilization, health care outcomes and proof of appropriate management of common illnesses, immunizations and cancer screening. The government could actually pay for results, not process. Primary care practices would have to be certified as producing an acceptable level of results and patients would have access to our success profiles both in terms of cost and quality when selecting their doc for next year. [Note: A standard is being defined by the Healthcare Delivery Innovation Alliance which is seeking outside input.]

The government could track the overall costs created by each practice and make those numbers public as well. The high cost practices would eventually lose certification, particularly if the money ended up in the hands of their employer (hospitals, big multispecialty clinics).

If the government wants to tackle the HotSpotters patients, they just need to up the monthly ante for the sickest patients – they will get their money back with huge interest from the reduced downstream costs and reduced transaction costs that these folks generate. With the big fees they will also be able to require more complete reporting of how their chronic illnesses are being managed.

Medicare should do the same – stop paying fee-for-service for Primary Care and start paying a fixed monthly fee (allowing patients to buy up if the government gets the price wrong, as it almost certainly would). The patient should have total control over which primary care doc gets the money – remember, we want to work for the patient, no matter who pays the bill.

So that’s the solution – a simple system where the patient is in charge, the government buys good basic care and the patients can buy up. The system itself is created within a free market structure which the government is simply choosing to ride (like food stamps and grocery stores) with patients running the show, so service and quality could go up every year while prices remain stable or decline – like any real functioning market system in the world. Direct Primary Care is the only available model that could accomplish these goals. Everyone else is still trying to figure out how to “work” the insurance system. However, if the government has wisdom, they would also make the monthly fee deal available to prior fee-for-service docs – to boost competition and to accelerate the conversion to Direct Primary Care models. The right incentives produce the right results. Notably, it’s a model supported by both Democrats and Republicans which augers well for its future.

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Off hand I can think of 5 different reasons why this would not work. Here in NY about 25% of all food stamps transactions are fraudulent purchases, where the vendor charges 200 to the card and in return the buyer gets beer and cigs. With medicaid some of our city clinics will write a script for painkillers and bill for 10 different things the government never checks. Some aspects of the model may work, but without addressing the fraud it’s just a bottomless money pit.

Sounds like a good plan. The only thing is Medicaid patients will not pay anything to the doctor. It’s the entitlement attitude that will be hard to break. It may take years. They dont want to pay $2 copay for office visits, how will they pay more? Its their unhealthy diet (available to them at our food stores), cell phones, home light bills that take up most of their monthly check. There are so many people on medicaid that need to be taken off the entitlement program. But Govt needs to get out of providing healthcare to all. Here is an interesting clip from 1962 when America was warned of the bad effects of Govt control of American healthcare.

Your proposal sounds good. I have advocated for several years for healthcare markets without monopolies and with transparency. If recent statistics on the price and performance of healthcare professionals and organizations are available to customers, they will be able to obtain the best care at the best price. It will also lead to reductions in the cost of malpractice premiums, overall better outcomes and reduced visits to doctors. Doctors should organize themselves more around groups that that serve the whole patient, general practioners, dentist, psychiatrist, maybe even a chiropractor or a DO willing to do some manipulations.

I like ideas that offer new ways of doing things. Of course the major problem is getting such a thing past the insurance and hospital lobbies, probably some doctor organizations and those in the electorate that believe the government shouldn’t be involved at all.

No doubt, there is a lot of inertia and the 80% of politicians who are really “Preservatives” (not true Conservatives or Progressives) — i.e., they are essentially paid to preserve the status quo. Having said that, necessity is the mother of invention. Patients and doctors (at least primary care MDs) are unsatisfied and gov’t budgets can’t sustain the current model.

Other commenters have mentioned fraud. Unfortunately, fraud is a factor in any model. At the same time, being able to convert food stamps for beer strikes me as more likely than individuals wanting to get extra prescriptions. All I know for sure is the current model isn’t sustainable and have yet to see an approach that is having as much impact as what I have seen with DPC.

Please check www.docs4patientcare.org Patients come first Govt needs to be on the sidelines Patients become customers People buy high ded plans with Health Savings accounts Doctors learn to adjust with people shopping around Dr Jani MD

Dave – I really believe that the DPC model will prove to be the long-term solution to primary care and I love the idea of stratifying by population. In addition to using DPC to serve the Medicaid and Medicare populations, I think practices focused on certain chronic disease conditions could be interesting as well. While the cost/patient would have the potential to be high at first, efficiencies gained by treating one condition could be great, not to mention the overall improvement/management of the condition over time. I guess the main obstacle – as with much of U.S. healthcare – is who will pay for it? Hopefully, one or more of the forward thinking DPC companies out there will take advantage of the ACA clause you cited and further innovate within the sector.

The DPC companies are all eager to partner with the health insurance companies that would provide the wrap-around. They are the primary log jam but there has been a spike of interest in the last 2-3 months that leaves me encouraged. Most health plans are aware that their traditional way of doing business is threatened (especially the regional health plans). Unfortunately some are deer in the headlights but others are making moves. One thing that will help them is the standard for DPC that HDIA.org is working on. WhiteGlove Health, MedLion and others are supportive of that standard that will make it easier for DPC models to scale.

It strikes me that not only are we facing a monumental (but not insurmountable) regulatory and political paradigmn shift re incentives, funding and access, but that at the individual patient and provider level, we have to provide both technical and cultural assistance with the transition to a model where a patient truly has more input to their decision re treatment options and specialists. The “white coat syndrome” affects not only our blood pressure when we confront our own mortality and illness, but our brains. We have been lulled into a sense of absolute and (not always) misplaced trust that the fee structure, insurance premiums and CARE in our healthcare system are accurate and appropriate (well, or we are suspicious and angry but have not other option). How do we ensure that any evolution to this DPC breaks underscores the Marcus Welby aspects and minimizes the “House” urban myth?